Don’t Stress Urinary Incontinence – We Got Your Bladder!
A Conversation with My Bladder:
There I was minding my own business when suddenly, my bladder decided to speak its truth.
Until this point, I made it through three vaginal deliveries, through all the exercise fads, step, kickboxing, what used to be called “aerobics” complete with an aqua colored spandex onesie and rainbow leg warmers (I drew the line at a headband), running outside “for fun,” tennis, and cardio dance without a hitch. Got through my 40s, menopause at 52 and thought I was safely sliding into my mid-50’’ when (record scratch) my bladder decided it was time to go on strike.
Me: “Uh, bladder. What was THAT!”
Bladder: “What was what?”
Me: “You know what I’m talking about, don’t make me say it!”
Bladder: “I have no idea what you’re talking about…”
Me: “You (note the YOU, not me) peed. Not in the bathroom. On the TENNIS court. During an OVERHEAD. What the heck?”
Bladder: “Yeah, well, there’s a new Sheriff in town. I’m tired of holding all that urine all the time. You think you pass three bathrooms and there are no ramifications? You don’t think I see ’em??”
Me: “Well this is not okay.”
Bladder: “Talk to the hand…”
Well played, bladder. Well played…
But, sadly for the old bladder, I have a few new tricks up my sleeve to manage such a situation. But first, let’s back up a bit and discuss ALL the ways a bladder can betray you.
LET’S START WITH THE ANATOMY
See how science-y and professional this article has suddenly become with the insertion of a hard to interpret medical rendering? Here’s the punchline: Weak or torn pelvic floor muscles and weakened tissue surrounding the urethra (aka the opening to the bladder) can lead to poor support around the urethral sphincter (aka the muscle that holds the urethra closed during tennis overheads and other (more trivial) activities of course.) When the sphincter doesn’t do its job, urine can leak out at inopportune moments. Often, at the most inopportune moments…like when you’re on line at the bank, or at a dinner party, or…
WHAT IS STRESS URINARY INCONTINENCE (SUI)?
Stress incontinence is the unintentional loss of urine due to a sudden pressure on the bladder and urethra, causing the sphincter muscles to briefly open. Coughing, laughing, sneezing, lifting something heavy, significant exertion during activity, running, jumping, screaming at your children – these are all classic activities that could lead to urine leakage.
WHY DOES THIS HAPPEN?
Because women don’t have enough going on with their lives. Let’s just throw an unsuspecting curve ball at them for yuks! There are certain conditions that increase the likelihood of injury or weakening of the pelvic floor muscles and tissue.
- Pregnancy
- Childbirth (vaginal deliveries mainly but even after C section, you may develop SUI)
- Weight gain
- Menopause
- Excessive or Repetitive strain on the pelvic floor (HEAVY weightlifting, LOTS of miles running or jumping, etc.)
TREATMENTS AVAILABLE FOR SUI
- Adult Diapers. There’s a non-starter. Nothing says “Let’s get it on” like an adult diaper… NEXT!!
- Poise pads. AKA – adult diapers with wings. NOPE!!
- Urethral inserts – a small, tampon-like disposable device inserted into the urethra before a specific activity, such as tennis. The insert acts as a PLUG to prevent leakage and is removed before urination. Uh, okay. OW!!!
- Pessary – a flexible silicone ring that you insert into your vagina and wear all day. The device is also used in women with vaginal prolapse. The pessary helps support the urethra, to prevent urine leakage. It’s like shoving a donut into your vagina in hopes that it will shut the urethra closed by pressure. Sometimes this works. Sometimes it doesn’t. Clearly not the inspiring confidence you were looking for…
- Incontinence Drainage bags – Have you seen these commercials? I’m going to lift the description of this thing from Amazon:
“The PureWick Female External Catheter (FEC) is a soft and flexible external catheter for women that draws urine away (from a bulky pad) to keep the body dry and odor free. (Well THAT’s nice, dry and odor free.) PureWick FEC should be discarded and replaced at least once every 8-12 hours or when soiled. (I would HOPE this is self evident.) Purchase of the DryDoc Vacuum Station is necessary to attach the External Catheter to tubing and properly draw urine away from the body.” So I’m assuming this is for sleep. Because I’m not sure it’s so discreet to drag around tubing and a vacuum station as you walk around the grocery aisles. Though nowadays, that may be 100% okay.
- Pelvic floor muscle exercises – Also known as Kegel exercises, these exercises can be quite effective for stress incontinence. To do pelvic floor muscle exercises, imagine that you’re trying to stop your urine flow.
- Tighten (contract) the muscles you would use to stop urinating and hold for five seconds, and then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.)
- Work up to holding the contractions for 10 seconds at a time.
- Aim for at least three sets of 10 repetitions each day.
- Electrical stimulation – I like to call this “Kegel’s on steroids.” Electrodes are temporarily placed into your vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation is administered over a 30 minute period. You will need multiple treatments over four months to see an improvement. It’s a kinder, gentler electric shock therapy for your vagina. A lot of these devices have popped up professionally and for retail sale. Do they work? One study found that both vaginal cones (these are little weights for your vagina) versus electrical stimulation therapy resulted in improvements in incontinence episodes. The problem is sticking with the treatments daily for at least four months and then continuing to do the stimulation to maintain the benefit.
- Artificial urinary sphincter – A fluid-filled ring is implanted around the bladder neck to keep the sphincter shut until there’s a need to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to flow. This is next-level, crazy town. The Bionic Bladder with remote control!! Where’s the MUTE button?
- Surgery using Slings and Mesh – Synthetic material (mesh) or strips of your body’s tissue (you read that correctly) are used to create a pelvic sling underneath your urethra. The sling helps keep the urethra closed, especially when you cough or sneeze. These surgeries are often very successful and I have a lot of patients who are happy post surgery. Obviously there are risks associated with these procedures and there were many public lawsuits regarding injuries sustained when mesh burrowed its way into the bladder and vagina. Thankfully, this is a very low percentage risk.
If these options are not particularly alluring there’s a new kid on the block. It’s called…wait for it…wait for it…
The EMPOWER platform!
WHAT IS EMPOWER RF?
The company that developed the EMPOWER platform dropped some serious coin on naming this device. Talk about marketing excellence: Empower….together, you and your vagina can conquer the world!!!!
The EMPOWER platform is a multi-system approach that will treat the following conditions:
- Stress urinary incontinence
- Urge incontinence (which urine loss due to bladder contractions associated with severe urge to urinate)
- Pelvic floor and vaginal muscle weakness
- Reduced sensation during sex
- Vaginal dryness and painful sex due to estrogen loss
- Non-invasive revision of the external labia to restore appearance and sensation
EMPOWER HAS FOUR TREATMENT MODALITIES TO TRANSFORM VAGINAL, BLADDER AND LABIAL HEALTH
V-TONE
The V-tone provides a non-invasive in-office treatment for stress, urge, and mixed urinary incontinence in women. It delivers the maximum EMS (Electrical Muscle Stimulation) contractions to rehabilitate weak pelvic floor muscles. Patients rest comfortably while pelvic floor muscles are targeted to increase strength. It is a fast, and highly efficacious, non-invasive treatment to address incontinence AND vaginal laxity.
Treatment time is between 20-60 minutes. The number of treatment sessions depends on the individual patient and is typically about six sessions, every 1-3 weeks but can vary according to patient response. Yearly maintenance treatments are recommended.
MORPHEUS 8V
The Morpheus 8V is a fractional radio frequency technology designed to remodel the vaginal tissue and the support tissue beneath the bladder. The improvement of the Morpheus 8V over older devices is its novel triple action technique that enhances the effect on tissue regeneration. This makes it a better option for patients with urinary incontinence issues as well as vaginal concerns.
The treated tissue shows an increase in the number of elastin and collagen fibers in both the superficial and deeper layers of the vagina. The energy is applied through microneedles that penetrate to deeper layers compared to older ablative technologies that are mostly impacting superficial tissue.
This Morpheus 8V addresses:
- Vaginal relaxation syndrome – characterized by a decrease in muscle tone and elasticity of the vaginal mucosa. Objectively, the disease is manifested by flabbiness of the walls of the vagina, gaping of the genital slit, subjectively – a decrease in erogenous reactivity, painful intercourse, and difficulty in achieving orgasm.
- Genitourinary syndrome – also known as painful, dry vagina, urinary frequency and urgency
- Stress Urinary incontinence
The number of treatment sessions depends on the individual patient’s needs. Generally 3-5 sessions are recommended every 3-6 weeks. Treatment time is 20-30 minutes following a 20 minute pretreatment with numbing cream.
FORMA V
Forma V is an advanced radio frequency device designed to correct vaginal thinning, which can cause pain and dryness, and labial laxity, wrinkling and reduced sensation. The Forma V treatment has two aspects, internal vaginal rejuvenation and external tissue remodeling with collagen and elastin formation. The treatment provides thermal energy, increased blood flow and improved tissue sensation. Win, win, win! The procedure takes about 10 to 15 minutes and feels like a mild to moderate warming sensation. No anesthesia is required.
MORPHEUS 8 BODY FOR LABIA
The appearance and tissue integrity of the labia may undergo undesired changes with time, after childbirth, or with menopause. Undesired being a bit of a euphemism. The Morpheus 8 body applicator targets the labia outside of the vaginal opening – just in case this is Gweneth Paltrow who doesn’t know that the vagina does not include the labia. The device delivers a radio frequency current through micro needling. This causes tissue contraction that can correct labial redundancy, undesired elongation and asymmetry of the external genitalia. An even labia is all the range now peeps. Wrinkles and looseness also improve as a result of this treatment. A topical anesthetic is applied beforehand to make the procedure more comfortable. A Bloody Mary or shot of tequila won’t hurt either.
And there you have it. The EMPOWER platform. Now you let your bladder know who’s the boss! And while you’re at it, might as well give your vagina and labia the facelift it deserves. If these lips could talk!
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For more information about my wellness programs and my practice, check out my website drsadaty.com. Hey Look! You are already here…
Ready for the legal disclaimer? Information offered here is for educational purposes only and does not constitute medical advice. As with any health recommendations, please contact your doctor to be sure any changes you wish to consider are safe for you!